United eServices

Account Overdue Balance Report

This report will not contain Account Balance information for UnitedHealthcare HMO Groups.

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Report for BKS:PCIS ID 11111 as of 2021-09-30

Policy Year	Policy #	Legal Entity	State	MLR Case Size	Account Overdue Balance Report	Aggregate Premium Revenue	Aggregate Rebate Amount Owed	Distributed Rebate Amt for Employer Policy
Broker Name	Employer Name	Customer No.	Policy No.	Pending Term Date	Total Past Due Balance	Customer Balance	Past Due Aging
Broker Name	Employer Name	Customer No.	Policy No.	Pending Term Date	Total Past Due Balance	Customer Balance	0-30 Days	31-60 Days	61-90 Days	91-120 Days	>120 Days
GEORGE W...	BRMS_UAT...	1019184	363383	2022-09-01	$1,811.00	$1,811.00	$0.00	$1,811.00	$0.00	$0.00	$0.00